Abstract

OBJECTIVES: To evaluate the emergency management of obstructing ureteral calculi with two different techniques (SWL and URS) with an emphasis on patients life quality. METHODS: A total of 80 patients presenting with acute colic pain due to a single obstructing ureteral stone were treated within 24 hours following the onset of pain with two different approaches in a randomized manner. Patients requiring DJ stent placement and/or auxiliary measures after both procedures were excluded and the remaining 65 patients were evaluated [Group1: ESWL (n = 34); Group 2: URS (n = 31)]. Patients were followed during 4-weeks period with respect to the analgesic requirement, number of renal colic attacks and emergency department visits along with the HRQOL scores.RESULTS: While 26 patients treated with URS (83.9%) were stone-free, 24 cases in SWL were stone-free (70.6%) after 4 weeks. Evaluation of the cases during this follow-up period demonstrated that cases undergoing SWL required significantly higher amount of analgesics when compared with URS group (p &lt; 0.001). In addition to the lower mean number of renal colic attacks and emergency department visits in URS group; both the mean HRQOL in terms of EQ-5D index and mean EQ-5D VAS values were also significantly higher in these cases when compared with the cases tretaed with SWL.CONCLUSIONS: Due to the negative impact of stone related events after emergency SWL on patients HRQOL, emergency URS may be applied more effectively with the advantages of prompt fragmentation of the calculi along with the immediate relief of obstruction and pain.

Comments 1

This report is a comparison of emergency treatment of proximal ureteral stones with SWL and URS. The result was evaluated after ONE session and residuals were removed with flexible URS. Despite the general statement that “smaller endoscopes…has led the endourologists to remove the ureteral calculi in a safe, quick and more cost-effective manner…” it is surprising that residuals were encountered in as many as 16% of patients treated with URS. Also the outcome of SWL is lower than expected and it is not mentioned if the 9 failures represented intact stones or were partially disintegrated. But there is no explanation provided why stones with a surface area of approximately 50 mm2 (diameter ~8 mm) and probably in the early phase of ureteral passage were not better disintegrated. With repeated SWL a much better result had been expected and also in the group of patients with residual stones after URS, SWL had been an attractive approach for re-treatment.

This report is a comparison of emergency treatment of proximal ureteral stones with SWL and URS. The result was evaluated after ONE session and residuals were removed with flexible URS. Despite the general statement that “smaller endoscopes…has led the endourologists to remove the ureteral calculi in a safe, quick and more cost-effective manner…” it is surprising that residuals were encountered in as many as 16% of patients treated with URS. Also the outcome of SWL is lower than expected and it is not mentioned if the 9 failures represented intact stones or were partially disintegrated. But there is no explanation provided why stones with a surface area of approximately 50 mm2 (diameter ~8 mm) and probably in the early phase of ureteral passage were not better disintegrated. With repeated SWL a much better result had been expected and also in the group of patients with residual stones after URS, SWL had been an attractive approach for re-treatment.